Can ED E/M codes be reported using telehealth?
Yes, during the COVID-19 pandemic, CMS added the ED E/M codes (99281-99285) to the list of approved Medicare telehealth services. This means that these services can be furnished via telehealth—or real time two-way audio and visual interaction. The place of service (POS) code used on the claim should be the same as if the service was rendered face-to face; for the ED that would be POS 23. This is true even if the patient is not physically located in the ED (e.g, patient is in a remote location, including the patient’s home). It is also allowed that the emergency physician may be in a different location, including at home. Modifier -95 should be added to these visits to indicate that they were performed by Telemedicine. This policy is retroactive to services provided after March 6, 2020. In the calendar year 2021 physician fee schedule final rule, CMS decided to keep these codes on the list of approved telehealth services through the end of the calendar year in which PHE expires. However, at the end of the PHE, the geographic rules revert to pre-pandemic locations. See FAQ 3.
Some commercial payers are adopting new POS codes for Telemedicine (02 and 10, see below). Please check with your payer to ensure the proper POS is used.
POS 02: Telehealth Provided Other than in Patient’s Home: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology
What documentation requirements are required to bill and ED E/M service via telehealth?
In general, you should document in the same manner as a face-to-face visit. Consider including the following documentation for your telehealth ED visits:
Are there geographic restrictions on the originating site for telehealth?
There are specific restrictions in place under Section 1834(m) of the Social Security Act that limit where telehealth services may be delivered. Specifically, telehealth services may only be performed in rural areas of the country and from certain health care facilities, requiring Medicare beneficiaries to travel to places such as a physician’s office, skilled nursing facility or hospital for the visit. However, under the CMS’ 1135 waiver, telehealth services may now be provided in all areas (not just rural), and any Medicare beneficiaries may receive these services from any location, including their homes. This applies to both new patients and those with whom the furnishing physician has a pre-established relationship. Once the PHE expires, the geographic restrictions return immediately (meaning that telehealth services can only be provided in rural areas once again and beneficiaries must travel to certain facilities to receive the service).
What if the patient does not have internet access or a smart phone?
During the pandemic, CMS will reimburse for audio-only telephone calls. CMS has temporarily added separate codes (CPT codes 98966-98968 and CPT codes 99441-99443) to the list of approved telehealth services. The codes are valued the same as the office and outpatient evaluation and management (E/M) codes. Note: Telephone services should not be reported for a follow up call related to a procedure by your same group.
Do EMTALA and HIPAA still apply for a telehealth ED visit?
An EMTALA mandated medical screening exam may be furnished via telehealth. Telehealth services may be delivered through telephones that have audio and video capabilities. The HHS Office for Civil Rights (OCR) is waiving penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html
What other services may be reported using telehealth?
CMS also allows reporting the critical care services (CPT codes 99291 and 99292), and the observation services (CPT codes 99217-99220, 99224-99226, and 99234-99236) to the list of approved Medicare telehealth services for the duration of the COVID-19 national emergency. CMS is also allowing the majority of these codes to remain on the list for an extended period of time—through the end of the calendar year in which the PHE ends. However, CMS explicitly decided not to extend a subset of the observation codes: CPT 99218-99220 and CPT 99234-99236. These codes will be removed from the list immediately once the PHE ends
What about virtual check ins and e-visits from the ED?
Medicare patients may have a brief communication service with practitioners via communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Clinicians may provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010, G2012) to both new and established patients. These services were previously limited to established patients.
Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists may provide e-visits. E-visits are non-face-to-face communications with a practitioner via online patient portals. (HCPCS codes G2061-G2063).
Clinicians may provide remote patient monitoring services to both new and established patients. These services may be provided for both acute and chronic conditions and may now be provided for patients with only one disease. For example, remote patient monitoring may be used to monitor a patient’s oxygen saturation levels using pulse oximetry. (CPT codes 99091, 99457-99458, 99473-99474, 99493-99494)
CPT coding guidance states that the remote physiologic monitoring service described by CPT code 99454 (device(s) supply with daily recordings or programmed alerts transmission each 30 day(s)), may not be reported for monitoring of less than 16 days. However, for purposes of treating suspected COVID-19 infections, Medicare will allow the service to be reported for shorter periods of time than 16 days as long as the other code requirements are met.
What about licensing and credentialing for telehealth services?
CMS has issued a temporary waiver to allow physicians who are licensed in one state to provide services to a patient another state. This applies to Medicare and Medicaid, and certain conditions apply. Further, in order for the waiver to be effective, the state where the physician is performing the telehealth service must also waive its licensure requirements.
CMS has not addressed the issue of credentialing with respect to telehealth and has pointed out that this is within the jurisdiction of the states to address.
CMS link for Telemedicine information: https://www.telehealth.hhs.gov/
The Interim Final Rules and waivers can be found at: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers
CMS has released guidance to providers related to relaxed reporting requirements for quality reporting programs at https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf
HHS Fact Sheet on ED Telehealth: https://telehealth.hhs.gov/providers/telehealth-for-emergency-departments/
9. What options are available in the emergency department to utilize telehealth services?
HHS has published a guide for the types of telehealth services that can be utilized in the ED. They include the following:
Tele-triage is like traditional triage but uses technology to supplement or replace elements of the patient interaction. Tele-triage involves screening patients remotely to determine the patient's condition and the care needed.
Tele-emergency medicine connects providers at a central hub emergency department to providers and patients at spoke hospitals (often small, remote, or rural) through video or similar telehealth technology.
Telehealth technology can be used by health care providers to check on emergency department patients virtually. This helps limit the number of providers who are physically present and exposed to contagious diseases. It also saves time and conserves personal protective equipment.
E-consults help providers get recommendations from other providers with specialty expertise.
Telehealth for follow-up care
Telehealth technology can also be used to provide follow-up care for patients who were triaged but not sent to the emergency department, or for patients after they are discharged from the emergency department.
Updated March 2022
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